EP0654247A1 - Vorrichtung zur endoskopische Chirurgie - Google Patents

Vorrichtung zur endoskopische Chirurgie Download PDF

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Publication number
EP0654247A1
EP0654247A1 EP93308315A EP93308315A EP0654247A1 EP 0654247 A1 EP0654247 A1 EP 0654247A1 EP 93308315 A EP93308315 A EP 93308315A EP 93308315 A EP93308315 A EP 93308315A EP 0654247 A1 EP0654247 A1 EP 0654247A1
Authority
EP
European Patent Office
Prior art keywords
tissue
heel
marking
lateral
bone
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP93308315A
Other languages
English (en)
French (fr)
Inventor
Gregoryd.P.M. Mcnamara
David Morley Jr M.D.
William Jr D.P.M. Donahue
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Endoscopic Heel Systems Inc
Original Assignee
Endoscopic Heel Systems Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority to US07/914,192 priority Critical patent/US5253659A/en
Priority to US08/041,947 priority patent/US5400768A/en
Priority to US08/084,859 priority patent/US5429117A/en
Priority to NO933743A priority patent/NO933743L/no
Priority to CA002108626A priority patent/CA2108626A1/en
Application filed by Endoscopic Heel Systems Inc filed Critical Endoscopic Heel Systems Inc
Priority to EP93308315A priority patent/EP0654247A1/de
Priority to AU49110/93A priority patent/AU4911093A/en
Publication of EP0654247A1 publication Critical patent/EP0654247A1/de
Priority to US08/481,841 priority patent/US5620446A/en
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A61B17/320036—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes adapted for use within the carpal tunnel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles

Definitions

  • the present invention relates to endoscopic surgery at locations in the body where tissue inserts into bone and more particularly to a method and system of performing endoscopic heel surgery.
  • Surgical intervention includes forming large incisions at or around the heel, surgical exploration or dissection to reach the plantar fascia, release of the plantar fascia from the os calcis, and excision of the degenerated fascial tissue and/or spur.
  • the system being able to overcome problems of the prior art to operate with greater precision than known before to minimize scaring, damage to tissues, identify a plurality of tissue and bone structures, and release tissue and/or resect bone.
  • the method and system should be adaptable to foot surgery with increased surgical precision, reduced trauma and damage to the vascular and neural structures for the remedy of plantar fasciitis such as in fasciotomies, fasciectomies, biopsies and resections of a spur on the os calcis. It is desirable to form a system that can perform multiple operations and procedures for the release of the plantar fascia and reduction of bone spurs that reduces recovery time and damage.
  • An object of the present invention to provide a system of a simple and easily operable construction being capable of use in the various surgical techniques for the remedy of plantar fasciitis.
  • the system features an improved sleeve member with a portal configured for visualisation of the insertion of tissue to bone.
  • the system for performing endoscopic surgery at the interface of tissue and bone using a sleeve member formed from an elongated tube with open ends and a portal.
  • the tube has slot segments extending inwardly from the open ends and the portal has edge portions interconnected to the slot segments located at a midportion of the elongated tube.
  • the portal forms an expanded surgical site with the advantage of simultaneous access and visualisation of the interface of tissue and bone.
  • the measurement system is advantageous for use in measuring and improving the precision of the resection of tissue and/or bone.
  • the instrument has an elongated shaft with proximal and distal ends, a handle attached to the proximal end and a locking device for attaching the handle to the shaft.
  • the distal end has a rounded forward portion extending transverse from the shaft, a cutting portion and an extension at the lower end of the cutting portion for guiding between layers of tissue and palpitating tissue.
  • the excision instrument has an elongated shaft with proximal and distal ends, a handle attached to the proximal end and a locking device for attaching the handle to the shaft.
  • the distal end has an operative portion at the distal end provided with a cutting section and a gathering section.
  • the cutting section has dual knives extending transverse from the shaft forming a slot releasing a section of tissue. The knives are spaced apart and offset at an angle relative to the longitudinal axis of the shaft. An extension at the lower end of the knives palpitates and guides between layers of tissue.
  • the gathering section has a tooth means positioned within the slot for gathering and removing a released section of tissue.
  • a procedure for performing endoscopic surgery in a patient to relieve a painful heel syndrome in a foot generally having a heel with skin, plantar fascia, vascular and neural structures, os calcis bone and muscles including the flexor digitorum brevis, abduct us digiti minimi, abductus hallucis.
  • a location and mark for an entry incision is determined on a medial side of the foot for avoiding the vascular and neural structures. Once the entry incision is made, a channel is formed between the os calcis, the plantar fascia, the aponulotic fibres of the muscles by bluntly separating the plantar fascia from surrounding soft tissue both superiorly and inferiorly.
  • the channel is formed to avoid the vascular and neural structures in the heel using a detachable obturator and sleeve member assembly.
  • the assembly is inserted and driven from a medial side to a lateral side of the foot until the assembly tents the skin on the lateral side where an exit incision is made.
  • the sleeve member and obturator are passed through to the lateral side of said foot to position and located a portal of the sleeve member at a predetermined operative site.
  • the predetermined operative site provides simultaneous visualization of the plantar fascia, the os calcis and the line of insertion of the plantar fascia into the os calcis.
  • the obturator is retreated from the sleeve member forming a medial and lateral opening at each end of the sleeve member and leaving the sleeve member located at the predetermined operative site.
  • An endoscope is inserted into the medial opening and an instrument into in the lateral opening.
  • a one or more surgical operations are performed at the operative site.
  • the operative site is cleaned, the obturator is reinserted and the obturator and sleeve member retracted.
  • the entry and exit incisions are sutured closed after successful performance of the desired surgical operations.
  • FIGS. 1-26, illustrate the preferred method and system of the present invention for the endoscopic release of the insertion of tissue into bone throughout the body.
  • the present invention is described in the environment for treatment of the painful heel syndrome which can include neuritis, myositis, fasciits and adventiteal bursitis with or without a calcaneal spur.
  • the endoscopic release of the plantar fascia at its insertion into the os calcis and/or resection of spurs has been successful for relieving pain in the heel.
  • the endoscopic system 20 of the present invention includes generally a cannula or sleeve member 22, trocar or obturator 24, fasciotomy instrument 110, excision instrument 160 and a marking and insertion assembly 230.
  • the sleeve member 22 provides an expanded portal 44 through which multiple surgical procedures such as a fasciotomy, fasciectomy, biopsy and heel spur resection can be performed at arcuate lines of insertion where tissue attaches to bone.
  • the sleeve member 22 of the present invention includes an elongated tube 34 with open ends 36 and 38, and slot segments 40 and 42 extending inwardly from the open ends 36 and 38, respectively.
  • a portal 44 is located at a mid portion of the sleeve member 22.
  • the portal 44 is connected to slot segments 40 and 42 by tapper portions 46 to thus extend along the length of the elongated tube 34.
  • the portal 44 further includes side edge portions 48 and 50 to form an access 52 to view the heel structures such as the os calcis, neurovascular structures and plantar fascia.
  • the access 52 allows an endoscope placed in, for example, open end 36 to form an image of these heel structures.
  • the access 52 also allows an instrument placed in the other open end 38 for surgical utilization on these heel structures.
  • the portal 44 can have width 56 determined by angle 52 so as to form an expanded view of the insertion of the plantar fascia into the os calcis and other heel structures.
  • the sleeve member 22 should be made to extend from either side of the foot, for example, having a length dimension of 10 cm.
  • the sleeve member 22 can be formed from suitable material such as non-reflective plastic to improve endoscopic imaging and to allow for the use of surgical lasers.
  • a collar or stop member 60 can be attached to end 36 of the sleeve member 22 to provide a grip when manipulating and as required for instruments or the like.
  • the sleeve member 22 and stop member 60 are configured to receive slidably obturator 24.
  • the stop member 60 includes a guide 62 located on an inner surface 64 of the stop member 60.
  • the guide 62 engages a stem 66 on the obturator 24.
  • the guide 62 and stem 66 are assembled to interlock for insertion into the heel and to indicate the alignment of the sleeve member 22.
  • Recess points 68 on the exterior surface 70 of the stop member 60 can be used advantageously for single handed gripping or for gripping with a ratchet (not shown) to rotate the portal 44 of sleeve member 22 into position adjacent the operative site.
  • the stop member 60 with tab portions 82 can interlock with nibble portions 84 adjacent either open end 36 or 38 of the sleeve member 22.
  • the obturator 24 includes a generally smooth shaft 72 with blunt tapered distal end 74 and handle 76 attached at the proximal end.
  • the sleeve member 22 slidably receives the shaft 72 along the length thereof with the blunt distal end 74 protruding from end 38.
  • the obturator 24 and sleeve member 22 are inserted through the foot with the portal 44 positioned adjacent the insertion of the plantar fascia into the os calcis.
  • the obturator 24 can have a central bore 86 along the length of the shaft 72 for use in engaging a guide wire 248 of the marking and insertion assembly 230 as described herein and shown in FIGS. 24, 25 and 26.
  • FIGS. 6, 7, 8 and 9 illustrate an additional embodiment of the present invention.
  • the sleeve member 54 is particularly useful in when performing a fasciectomy or excision of sections of the plantar fascia and in biopsy of tissue.
  • the sleeve member 54 has a non-uniform cross-sectional aperture with an instrument portion 78 and register portion 80.
  • the larger dimension of the instrument portion 78 increases the working area to accommodate excision or biopsy instruments such as a rotary abrader, jaw-like forceps used in sampling tissue or other instruments.
  • the register portion 80 can allow the surgeon to hold the endoscope against the arcuate surface 88 as a means for steadying during resection of tissue or bone spurs using a rasping instrument (not shown).
  • the register portion 80 also provides increased space and maneuverability for instruments when operating on tissue or bone.
  • the shaft 72 of obturator 24 can be slidably received in sleeve member 54 having upper protrusion 90 and lower protrusion 92 that engage the instrument and register portions 78 and 80, respectively.
  • the obturator 24 of can be advantageously configured with either a bill shaped dissector tip 94 or a blunt tip 96 at the distal end 74 for separating tissue.
  • FIGS. 11-13 illustrate another embodiment of the present invention particularly useful for endoscopic reduction of bone.
  • the sleeve member 22 or 54 can include a flange 98 for engaging tissue along the line of insertion and exposing bone.
  • the flange 98 can formed at the side edge portions 48 and 50 of the portal 44. As illustrated in FIG. 6, the flange 98 can be formed at the side edge portions 48 and 50 of sleeve member 54 with the flange 98 adjacent instrument portion 78 and spaced apart from register portion 80.
  • a measurement portion 100 can also be used in conjunction with the flange 98 to gauge precisely the reduction or resection of bone.
  • the measurement portion 100 can be formed adjacent side edge portions 48 and 50 that includes a gradient 102 and scale 104.
  • the gradient 102 varies the dimension of the wall 106 forming edge portions 48 and 50 or the wall 108 of the flange 98.
  • the scale 104 can be calibrated with the gradient 102 to provide a reference when reducing bone.
  • the measurement portion 100 can be used advantageously in bone or spur removal to a greater precision than previously known in the art, thereby decreasing trauma and speeding recovery.
  • a fasciotomy instrument 110 for dividing the plantar fascia includes an elongated shaft 112 having opposing proximal and distort ends 114 and 116, respectively.
  • the proximal end 114 can have a notch 118 configured for use with the locking and release feature of the handle 130.
  • the distal end 116 has an active portion 120 configured to improve the surgical operation of releasing the plantar fascia.
  • the active portion 120 includes a hook portion 122 extending transversely from the shaft 112, a knife portion 124 along the interior of the hook portion 122 and a palpitation extension 126.
  • the knife portion 124 can be formed in a concave shape 128 adaptive to center and cut the plantar fascia.
  • the knife portion 124 also can be formed straight and angled relative to the elongated shaft 112 to provide for retrograde division from medial to lateral of the plantar fascia, as shown in FIG. 15.
  • the palpitation extension 126 extends proximally beyond the knife portion 124 and is adapted to hook under and extravasate from the plantar fascia to palpitate the underlying fat pad during division of the plantar fascia.
  • the instrument handle 130 includes an shell 132, a recess 134 along surface 136 of the shell 132, and a chamber 138.
  • the handle 130 features an activation system 140 for interchanging instruments with the handle 130 such as when used in the release of the plantar fascia.
  • the activation system 140 includes a release member 142 having posts 144 and 146, rocker bar 148 with knob 150 and a spring 152.
  • the release member 142 extends from the chamber 138 through recess 134 configured to receive a button 154 attached to the release member 142.
  • the handle 130 can accept insertion of the shaft 112 through hole 156 and into engagement with knob 150.
  • the spring 152 is biased so that depression of button 154 causes the rocker bar 148 to pivot and disengage knob 150 from notch 118 thereby allowing for removal of shaft 112.
  • the instrument handle 130 can be formed from plastic or other suitable materials.
  • the excision instrument 160 includes an active or operative portion 162 located on the distal end 116 of shaft 112.
  • the operative portion 162 has cutting section 164 and gathering section 166.
  • the cutting section 164 has dual laterally spaced knife portions 168 and 170 extending transverse from the shaft 112.
  • the knife portions 168 and 170 spread slightly at angle 172 for improving the cutting of tissue.
  • the palpitation extensions 174 and 176 extends proximally beyond the knife portions 168 and 170 and is adapted to hook under and extravasate from the plantar fascia to palpitate the underlying fat pad during excision.
  • the gathering section 166 has snagging member 178 that snags and removes cut tissue from the wake of cutting section 164.
  • the incision instrument 160 can be used with sleeve member 22 or within the instrument portion 78 of member 54.
  • FIGS. 20 and 21a and 21b a procedure for performing endoscopic heel surgery according to the present invention is described.
  • the patient is placed on the operating table in a prone position having the legs extending from the operating table with the feet dangling downwardly.
  • the foot 180 is locally anesthetized and the skin cleaned for forming incisions.
  • the knee can be flexed elevating the foot 180 with respect to the operating table to minimize impedance from the other leg and to manipulate the foot to substantiate the release of the plantar fascia.
  • the sleeve member 22 or 54 is driven into the foot 180 from a medial aspect 182 to a lateral aspect 184 of heel 186.
  • the foot 180 is comprised of a web of compacted overlapping tissues such as, for example, plantar fascia 188 attached to the os calcis 190 at a line of insertion 192.
  • a spur 194 can develop on the os calcis 190 from the pull and degeneration of plantar fascial tissue 188.
  • a fat pad 196 overlies the os calcis 190 and has nerve branch 198 and vascular branch 200 interwoven therebetween.
  • the plantar fascia 188 overlies muscles 202 including a flexor digitorum brevis group 204, abductus hallucis group 206 and abductus digiti minimi group 208.
  • the sleeve member 22 is positioned distal of the os calcis 19 and between the dorsal underlying plantar fascia 188 and superior muscles 202 avoiding the nerve and vascular branches 198 and 200, respectively.
  • the portal 44 is positioned plantarly and superior to the plantar fascia 188 and distal of the os calcis 190 to provide access and visualisation of the line of insertion 192. Visualisation can be made with a standard 30 degree angulated 4.0 nm arthroscopic camera system 222.
  • the portal 44 provides clear assessment of the plantar fascia 188, os calcis 192 at the line of insertion 192.
  • the camera system 222 is introduced through the open end 36 on the medial aspect 182 of the foot 180.
  • the other open end 38 is used as a working portal for the introduction of various surgical instruments to operate caudally on the line of insertion 192 such as for the transection of the plantar fascia 188 and removal of spur 194 on the os calcis 190.
  • an endoscope can be inserted into open end 36 and an instrument into the other open end 38.
  • a first and second surgical operation is performed at the operative site.
  • the obturator 24 is reinserted and the sleeve member 22 and this assembly is retracted while forcing plantarly the tip 94 or 96 of the obturator 24 again substantiating the complete division of the plantar fascia with the tip 94 or 96 coursing the fat pad 196 underneath the plantar fascia 188.
  • the operative site is cleaned and lavaged with copious amounts of sterile saline.
  • the entry and exit incisions 218 and 220 can be sutured closed with a solitary suture and dressed with a dry sterile compression dressing after successful performance of the desired surgical operations.
  • the fasciotomy instrument 110 can be used to divide caudally the plantar fascia 188 from the medial aspect 182 to lateral aspect 184 with visualisation directed via the camera system 222.
  • Direction of the medial to lateral division is made in the caudal approach to avoid damage to the nerve and vascular branches 198 and 200 located on the medial aspect 182 of the heel 186.
  • the fasciectomy instrument 160 can be used to excise caudally a section of plantar facial tissue 188 as illustrated in FIGS. 18 and 19. Extravasation of the palpitation extension 126 from the plantar fascia 188 and fat pad 196 can be felt through the shaft 112 is an indication of the release of the plantar fascia 188.
  • the release of the plantar fascia could be externally substantiated only by palpitation of the dorsal skin or texture of the foot 180.
  • the palpitation portion 126 has the advantage of providing an indication and feel of the release or total division of the plantar fascia 188 during transection.
  • the use of the expanded portal 44 has the advantages of enabling visualisation of the deep cut apex of thick tissue.
  • a location 210 on the medial aspsect 182 of the heel 186 is determined to avoid damage to the nerve branch 198 and vascular branch 200.
  • the location 210 can be determined using a non-weight bearing lateral radiograph of the foot 180 and the marking system 230 described herein.
  • the lateral radiograph can be used to measure and triangulate the distance between edge 212 and tuberoscopies 214 and 216 of the os calcis 190.
  • An entry incision 218 is made on the medial aspect 182 of the heel 186 at the determined location 210, as shown in FIG. 21a.
  • the size of the entry incision 218 can vary, for example, incisions ranging from 2 cm to 4 cm.
  • a channel between tissue and bone can be formed by driving the obturator 24 and the sleeve member 22 assembly through the entry incision 218 from medial to lateral until the surgeon can see tenting of the skin on the lateral aspect 184 of foot 180, as shown in FIG. 21b.
  • the tip 94 or 96 forms the channel by bluntly separating the plantar fascia 188 from muscles 202 and other surrounding soft tissue both superiorly and inferiorly.
  • An exit incision 220 is made at the location of the tented skin with the assembly passed through the foot.
  • the portal 44 should be positioned superior to the plantar fascia 188 and adjacent the os calcis 190 before removing the obturator 24.
  • the location 210 for insertion of the obturator 24 and the sleeve member 22 assembly can be determined before surgery by visualising using a lateral radiograph or x-ray of the foot 180 to identify the location of tuberoscopies 214 and 216 or spur 194 such as the distal tubercle margin of the os calcis 190.
  • the marking and insertion system 230 of the present invention can be used in conjunction with the lateral radiograph for precise insertion of the assembly avoiding damage to neurovascular structures 198 and 200.
  • the system 230 includes a heel holding member 232, location member 234 and insertion member 236.
  • the heel holding member 232 can attach and use the location member 234 for no-sterile or non-surgical site use to determine location 210 prior to surgery. Thc heel holding member 232 can then attach and use the insertion member 236 in the surgical setting.
  • the location member 234 is calibrated correspondingly with the insertion member 236 so that the location 210 determined by the location member 234 has a corresponding location on the insertion member 236.
  • the system 230 can be formed from suitable materials such as a radiograph opaque plastic or the like.
  • the generally L-shaped heel holding member 232 has a base pinion 238 realisably attached to an end portion 240 to keep the foot in a neutral portion such as 90 degrees.
  • the end portion 240 can be attached to either side of the base portion 238 using thumb screws 242 allowing adaptation of either a right or left foot.
  • location member 234 can be attached to the base portion 238 using thumb screws 242 and allows interchanging the location member 234 for either foot.
  • Both the location member 234 includes a reference scale 244 laminated or otherwise disposed within the opaque plastic of the location member 234 to superimpose or capture the reference scale 244 on the lateral radiograph for use in marking the location 210 for marking the entry incision 218.
  • the insertion member 236 includes a grid portion 246 corresponding to the reference scale 244 for use in inserting a guide wire or pin 248.
  • the coordinates of the determined location 210 on the lateral radiograph can be transferred to the grid portion 246 to insert guide wire 248.
  • the foot 180 for the lateral radiograph the foot is positioned in the heel holding member 232 with the medial aspect abutting the location member 234.
  • the location member 234 is interchanged with the insertion member 236 at the time of surgery.
  • the insertion member 236 includes elongated guide tube 250 arranged and calibrated to correspond to the grid portion 246.
  • the guide wire 248 is inserted into the guide tube 250 corresponding to location 210.
  • the elongated guide tubes 250 provide for insertion of the pin 248 from the medial 182 to lateral 184.
  • the system 230 using the insertion member 236 can be removed from the medial extension of guide wire 248 thereby leaving the guide wire in the foot.
  • the obturator 24 and sleeve member 24 can use the guide wire 248 as to guide the medial to lateral separation of tissue.
  • the bore 86 can be configured to receive the guide wire 248 and follow the predefined path of guide wire 248. Once the sleeve member 24 or 54 is properly positioned, the guide wire 248 can be removed from the lateral side 184 of the foot 180.
  • the marking and insertion system 230 of the present invention can be used advantageously to locate more precisely the entry incision 218 and avoid damage to neurovascular structures 198 and 200, and likewise be used adaptively to insert guide pin 248 through the foot 180.
EP93308315A 1992-07-14 1993-10-19 Vorrichtung zur endoskopische Chirurgie Withdrawn EP0654247A1 (de)

Priority Applications (8)

Application Number Priority Date Filing Date Title
US07/914,192 US5253659A (en) 1992-07-14 1992-07-14 Method and system for performing endoscopic surgery at locations where tissue inserts into bone
US08/041,947 US5400768A (en) 1992-07-14 1993-04-02 Method and system for performing endoscopic surgery at locations where tissue inserts into bone
US08/084,859 US5429117A (en) 1992-07-14 1993-06-29 Method and system for performing endoscopic surgery at locations where tissue inserts into bone
NO933743A NO933743L (no) 1992-07-14 1993-10-18 Fremgangsmåte og system for gjennomföring av endoskop-kirurgi
CA002108626A CA2108626A1 (en) 1992-07-14 1993-10-18 Method and system for performing endoscopic surgery at locations where tissue inserts into bone
EP93308315A EP0654247A1 (de) 1992-07-14 1993-10-19 Vorrichtung zur endoskopische Chirurgie
AU49110/93A AU4911093A (en) 1992-07-14 1993-10-19 Method and system for performing endoscopic surgery at locations where tissue inserts into bone
US08/481,841 US5620446A (en) 1992-07-14 1995-06-07 Surgical apparatus for performing endoscopic surgery at locations where tissue inserts into bone

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
US07/914,192 US5253659A (en) 1992-07-14 1992-07-14 Method and system for performing endoscopic surgery at locations where tissue inserts into bone
NO933743A NO933743L (no) 1992-07-14 1993-10-18 Fremgangsmåte og system for gjennomföring av endoskop-kirurgi
CA002108626A CA2108626A1 (en) 1992-07-14 1993-10-18 Method and system for performing endoscopic surgery at locations where tissue inserts into bone
EP93308315A EP0654247A1 (de) 1992-07-14 1993-10-19 Vorrichtung zur endoskopische Chirurgie
AU49110/93A AU4911093A (en) 1992-07-14 1993-10-19 Method and system for performing endoscopic surgery at locations where tissue inserts into bone

Publications (1)

Publication Number Publication Date
EP0654247A1 true EP0654247A1 (de) 1995-05-24

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
EP93308315A Withdrawn EP0654247A1 (de) 1992-07-14 1993-10-19 Vorrichtung zur endoskopische Chirurgie

Country Status (5)

Country Link
US (3) US5253659A (de)
EP (1) EP0654247A1 (de)
AU (1) AU4911093A (de)
CA (1) CA2108626A1 (de)
NO (1) NO933743L (de)

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US5253659A (en) 1993-10-19
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AU4911093A (en) 1995-05-25
CA2108626A1 (en) 1995-04-19
US5400768A (en) 1995-03-28
US5429117A (en) 1995-07-04

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